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Commissioning and contracting has been used extensively by the British and Australian governments for many years. In fact it goes back so many years that one could argue that Australia owes its existence, or at least its English heritage, to commissioning.

The initial wave of colonisation was financed through contractual arrangements for the First Fleet in 1787 and was followed over the next few years by the Second and Third Fleets with similar arrangements. The effectiveness of these arrangements was variable on some measures. The death rate of the prisoners on the Second Fleet was 40%.

Commissioning started to be used extensively in Britain following the election win in late 1979 by Margaret Thatcher’s Conservative government that had followed the “Winter of Discontent”, marked by widespread strikes under Labor.

Commissioning came to the fore in Australia under the NSW Greiner government in the late 80s and was led by the Premier’s Secretary, Gary Sturgess. Sturgess worked extensively in Britain in government and private practice in the 2000s before resigning his position as Executive Director of the Serco Institute in 2011 to return to Sydney, where he now holds the chair of Public Service Delivery at the Australian School of Business, University of New South Wales. He has, however, continued to work as an adviser in Britain, most recently in 2017, with his paper Just Another Paperclip.

Medicare, the government voucher system for out of hospital medical services, is now 36 years old. It has enjoyed widespread support over that time and, while opposed by the medical profession initially, and certain politicians since, albeit not publicly, it has become accepted by health professionals and the general public. For many Australians it is the only system they have ever experienced.

Medicare is similar to other national health schemes found in the developed world and while most agree it is not perfect they are glad it is not what we see in the USA.

This model of government financing the medical sector has in recent years been extended to aged care services, disability care, and mental health support. The government offers packages of care in a competitive market for contractors to supply the designated services to clients.

Contracts are awarded to large organisations that are incentivised to employ staff with minimum qualifications for fixed periods of time. The focus is on doing the minimum required in the shortest period of time to meet the requirements of the contract. Fast and cheap! (See Good, Fast, Cheap - Pick Any Two)

COVID-19 has been a shock to many businesses and in a lot of cases will cause many operations to cease. At this stage, there is no way of knowing how long this health and economic crisis may last. COVID-19 businesses can be broadly classified into the following categories:

Best case – limited impact to usual trading conditions

Likely – some impact to trading. Reduced activity and revenue, increased costs to meet social distancing requirements, disruption to supply chains, employees inability to work due to third party closures, inefficiencies in productivity if they need to work remotely, etc.

Worst case – forced closure periods or complete closure

There are a range of actions that your business may need to consider and implement to manage the risks associated with COVID-19. Actions should be designed after assessing the current financial status of the business so any measures introduced will assist with navigating through the crisis and also position the organisation to take advantage of the eventual recovery.

As if the expected upswing in presentations and admissions from coronavirus isn’t enough to send shockwaves through public hospitals the latest performance figures show that facilities run by the Northern NSW Local Health District are already bursting at the seams.

Data released in the Bureau of Health Information’s Healthcare Quarterly Oct-Dec 2019 confirm that hospitals within the LHD’s remit (Maclean up to Tweed Heads) faced a demand increase on almost every indicator, including arrivals at ED by ambulance (up by 4.1 per cent to 8416 over the past year), a 6.8 per cent rise in elective surgery, and longer wait times, and a 5.7 per cent increase in admitted patient activity.

In the year analysed, 19 more babies were born in Northern NSW public hospitals.

Despite these increased pressures, the system generally coped well, sitting close to the NSW average results in most areas, and bettering them in some: Median time for patients to leave the ED is now 2h 04m – 51 minutes under the NSW average.

In the latest issue of GP Speak we ran a cover photo of Alstonville GP Luke Hogan performing in Ballina Players’ excellent production of Wicked, The Untold Story, and a story about the wealth of theatrical shows that would be upcoming for the rest of this year. Local doctors were well represented on stages and behind the scenes,

The card for Ballina Players included the blockbusters Mamma Mia and Priscilla, Queen of the Desert, with the story more generally profiling offerings from the Lismore Theatre Company in the recently refurbished Rochdale Theatre, and the unfolding season of the Lismore City Hall based NORPA.

No one could have possibly predicted that soon after the Autumn issue of the magazine was released all of these shows would be cancelled, along with the closure of all Northern Rivers galleries, museums, sporting events, restaurants and cafes, and many of the businesses that were only starting to rebuild after the flood of two years ago.